Healthcare Provider Details

I. General information

NPI: 1265690390
Provider Name (Legal Business Name): NEVER GIVE UP COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 TRAIL ONE
BURLINGTON NC
27215-5535
US

IV. Provider business mailing address

303 TRAIL ONE
BURLINGTON NC
27215-5535
US

V. Phone/Fax

Practice location:
  • Phone: 336-222-8610
  • Fax:
Mailing address:
  • Phone: 336-222-8610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberMHL-041-840
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberMHL-041-840
License Number StateNC

VIII. Authorized Official

Name: MR. ADRIAN TERRELL FUNCHESS
Title or Position: CEO/OWNER
Credential:
Phone: 336-501-8643